Date: 26 November 2013
Bilateral upper-lobe cavities in AIDS, pt PC
Copyright: n/a
Notes:
This patient, thought initially to have pulmonary aspergillosis in AIDS, has bilateral upper-lobe cavities, more marked on the left. He presented with fever, nonproductive cough and dyspnoea. Bronchoscopy yielded Aspergillus fumigatus. He refused therapy and died with progressive disease. He is reported as patient 8 in Denning DW, Follansbee S, Scolaro M, Norris S, Edelstein D, Stevens DA. Pulmonary aspergillosis in AIDS. N Engl J Med 1991; 324: 654-662.
Images library
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Bronchoscopic manifestations of Aspergillus tracheobronchitis. (a) Type I. Inflammatory infiltration, mucosa hyperaemia and plaques of pseudomembrane formation in the lumen without obvious airway occlusion. (b) Type II. Deep ulceration of the bronchial wall. (c) Type III. Significant airway occlusion by thick mucous plugs full of Aspergillus without definite deeper tissue invasion. (d) Type IV. Extensive tissue necrosis and pseudomembrane formation in the lumen with airway structures and severe airway occlusion (Wu 2010).
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High resolution CT showing centrilobular nodular opacities and branching linear opacities (tree-in-bud appearance) (Al-Alawi 2007).
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Chest X-ray showing poorly defined bilateral nodular opacities (Al-Alawi 2007).
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Gross pathologic specimen from autopsy shows the bronchial lumen covered by multiple whitish endobronchial nodules (arrows) (Franquet 2002).
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Invasive tracheobronchitis showing numerous nodules seen during bronchoscopy (Ronan D’Driscoll).
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Pseudomembranous seen overlying the bronchial mucosa (Tasci 2006).
